Race Matters in Getting Stroke Treatment, Study Finds
July 14, 2011 – Blacks are less likely than whites to receive critical stroke care, mostly because they do not get to a hospital soon enough for time-sensitive treatment and often have pre-existing medical conditions, according to a new Georgetown University Medical Center (GUMC) study.
Such pre-existing conditions preclude the use of the most effective drug for strokes, tPA.
After accounting for the differences, the study found the treatment rate for tPA-eligible blacks and white patients to be similar.
The researchers conducting the study, published in the June 30 issue of the American Stroke Association’s journal Stroke, reviewed nearly 1,000 patient records from the seven acute care hospitals in Washington, D.C.
The study probably can be generalized to other urban communities in the United States, says Dr. Chelsea Kidwell, director of the Georgetown University Stroke Center.
She says the good news is that the results of the study provide important information on how to improve stroke treatment care in African-Americans in the future.
The researchers looked at whether patients received the best drug possible to treat the most common type of stroke – ischemia. An ischemic stroke is caused by a blood clot that blocks blood flow in the brain.
The drug tPA, or tissue plasminogen activator, is designed to break up the clot, which can reduce the effects of a stroke and reduce permanent disability. Administered intravenously at a hospital, tPA must be given within a few hours after the patient’s initial symptoms.
The study found that blacks in Washington were a third less likely to be treated with tPA than whites, Kidwell explains. She says understanding the reasons for this disparity are critical for making changes in the future.
The researchers also found that blacks were more likely to arrive at a hospital after the narrow treatment window during which tPA must be administered to be effective.
But even if African Americans arrived within three hours of the onset of symptoms, they were still half as likely to be treated with tPA than whites. This appears to be because of a greater rate of pre-existing medical conditions such as uncontrolled hypertension, a recent stroke or use of blood thinners among blacks, Kidwell explains. These conditions make tPA administration unsafe.
Uncontrolled hypertension accounted for 9 percent of the patients that didn’t receive tPA. An additional 10 percent had hada recent stroke or evidence of a prior hemorrhage.
Kidwell says interventions to increase stroke treatment for blacks should focus on culturally relevant education programs designed to address barriers specific to this population.